Test Administration Form Accessibility Faculty Resources at MSU Moorhead

*indicates a required field

Student Name(s):*

Course and Section #:*

Instructor Name:*

Instructor Email:*

Instructor Office:*

Details for Administering Tests

Exams

Dates:

Time Allotted for Exams (WITHOUT the addition of this student's extended time accommodation):

Approved Start Time:

Quizzes

Dates:

Time Allotted for Quizzes (WITHOUT the addition of this student's extended time accommodation):

Approved Start Time:

Final Exam

Date:

Time Allotted for Final Exam (WITHOUT the addition of this student's extended time accommodation):

Approved Start Time:

Approved Resources

Calculator:* Yes No

Computer:* Yes No

Computer with internet connection:* Yes No

Dictionary:* Yes No

Notes:* Yes No

Blank scratch paper provided by Accessibility Resources:* Yes No

Books, Articles, etc:* Yes No

Scantron:* Green Full Sheet Blue Half Sheet Red Half Sheet None

Does Accessibility Resources have permission to copy this exam for student who may schedule at a later time?* Yes No

What are the parameters for using supplemental materials?

Delivery & Return Preferences

How will the test be delivered to Accessibility Resources?* Email to accessibility@mnstate.edu Fax to (218) 477-2420 Instructor or designee will deliver the exam to Accessibility Resources Campus Mail (may take 2-3 days; Campus Mail is not recommended) Test will be administered as a proctored online exam

How should the test be returned to you?* Deliver hard copy Instructor or designee will pick up exam at Accessibility Resources Email or fax it to me (provide information below) Campus Mail (may take 2-3 days; Campus Mail is not recommended) Test will be a proctored online exam; results submitted online

Other Instructions:

Test Administration Request

Details for Administering Tests

Approved Resources

Delivery & Return Preferences